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Chain of custody form, STL Edison analysis request

Machine-extracted title · confidence 88%

Document establishing the chain of custody for samples submitted to STL Edison for environmental analysis.

NYC-WTC_000186417
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Scanned page image, NYC-WTC_000186417
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OCR status: ok · source: pdftotext

NYC 9/11 Public Portal Document

o STL EDISON o 777 New Durham Road Edison, New Jersey 08B17 CHAIN OF CUSTODY/ANALYSIS REQUEST to \ ts3 Phone; (732) 543-3900 Fax; (732) 549-3679 PAGE LofJ O 'O N5 Name ((or report and invoice ) Samplers NamB^X-Ennifid ) Sile/Project Idenllficallon / . CJ

P.O.# I state (LoeaBon of site): NJ; □ NY;^^ Ottiar: tn Company . - >i > O> Regutatery Program: TO > Address / , , Xiu lysli luntacound Tims I AKALYStSneOUmED (EKTEATOSELOAIlOINQlCATlREauErri LAB USE ONLY

Clty--^ StatB _ Standard L]

Rish Craraa AuOiaiiied Far I

/ / / I il I Project No: •50 tc

□ 03

a avzeek Job No: tS3

Phono < Fax 1 Wee* ’)? 9 q Vs (1101 (Lj co 0 Bier tn

Sample Identification Oats Tima No. of. Matrix Cant. 5\d Sample Numbers o

J. // y Y ID SE O X3 m H 50 TO 2 a sc // ZZ3t»»^,47C^/,^ X x: cVAAni > as TO X o > z

Praservallon Used: 1 = ICE, 2 = HCI, 3 = HjSO4. 4 = UNO,, 5 = rfaOH Soil: 6 = Ottiar 7 = Oiher Water

Special Instructions. _____ :_____________ _ Water Metats Filtered (Yea/No)*? Q Rehjgtrehed by^" '™ _/0^/nma RecatvedMr Campany H ir hO ^Inquished by Company Dato/Time Received by Company s O I 2) o 2L — Relinquished by Company Dais / Time Received by Company S o I o o o o 3)___________ I 3) 03 X co Relinquished by Company Dale I Time Received by Company o o CO 03 co 4) 0*1

NYC-WTC_000186417

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NYC-WTC_000186417Source: NYC Law Department, mirrored locally

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